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1--0; 1 1 1 :a141AH FRr'' AGE NC 209 9S6 Ef700 P. 1 <br /> 'pr io ko--goi <br /> SAN J AQUI COUNTY <br /> !_T. PUBLic HEALTH SLRvic r&r.�-L 7 <br /> ENVIRONNOtNTA'L HEALTH DIVISION <br /> 113 IC RECORDS RELEASE Al"PLICATION <br /> AppLICAN jj,, �l7Ga�+...��n n.rr.aTt1I rh`J.f -HONH NQ 5j Q j b_! <br /> ADDRESS_Lam,_W. l%4AAjkj Lama}F.4f I} } Siq ►chap C <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS .PAD AQgti-Cy D <br /> ?,y 3 D o 145 <br /> E. 4 <br /> _95c1 E )n:� rs�rac,1 QRir 4 <br /> it 44-7 PAN <br /> TATS NOTICE IS SUBJECT TO TIIE REQUIREMENTS IDENTIFIED IN "111E PUBLIC WEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(F-HO)POUCY#92-007.ORDINANCE CODE OF SAN <br /> JOAQLJlb' n..+ra.,r.v .^:... vrrro aam enni�na -4-01-11 kE.SOL.UTIONS, STATE WATER CODF- <br /> GOVERN 1 <br /> 1. A I I�;I�J CfI e y'� I I�' IYl C� {l_ PER REQUEST. <br /> -, )(NTM� LYY <br /> N . APPOINTMENTS ARE <br /> ARRANG C �- � hat) CL S FOR APPOINTMEN'T'S ARE SCHEDULED <br /> HONDA' ,/ M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. I Pc, L TQ CL <br /> 3 ,pen Cl 1 (l(\ )A NON-REFIINI)AIJI_N DEPOSIT OF$78.00 <br /> IS REQU, J APFUCANT IF THE (•11..E.SIRECOKDS ARE <br /> NOT AVS <br /> 4. Z 'OWARDS THE Tal'AI, FILE REVIEW FEE <br /> CHARGE ND PAYABLE MUOR TO REVIEWING TfIE <br /> 5_ P I,V�C�- SAME CONDITION AS RECEIVED WILL BE <br /> CORPEC 1F THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILIXD TO TIIC APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT ��^ cz�4 ual DATE 3 <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> LII 00 14 (REV 12192) <br />